Connecticut officials have crafted a five-year, billion-dollar strategy to improve the health of the state’s rural residents.
Last month, the Department of Social Services requested roughly $938 million from the federal government for the effort. The funding would come from the Rural Health Transformation Program — created as part of the One Big Beautiful Bill Act, or H.R. 1, that President Donald Trump signed into law in July.
Connecticut’s sprawling plan includes 31 different initiatives focused on increasing care options in rural areas and facilitating access to that care, Kyle Kramer, CEO of Day Kimball Hospital in Putnam, said. Day Kimball, one of Connecticut’s four rural hospitals, is currently independent, but working through the details of an acquisition by UConn Health, the state’s flagship medical institution.
“If we’re really focused on improving health, it starts with access,” Kramer, who worked closely with DSS to put together the state’s application, said. “Are there enough options and opportunities for people to get to care? And, if they exist, can they actually get to those locations from a transportation standpoint?”
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The state’s pitch includes several programs aimed at strengthening the rural health care workforce, including provider incentives, residency grants, expanded training opportunities and implementing interstate licensure compacts.
The plan includes initiatives meant to reduce or eliminate travel times for accessing care, like rolling out mobile medical and dental vans, as well as expanding telehealth options. There are also programs that seek to improve overall wellness: bringing evidence-based exercise classes to senior centers and making upgrades to existing trail systems.
A handful of the proposed initiatives would require sign-off from state lawmakers, including streamlining the state’s “certificate of need” approval process for major hospital transactions — such as mergers, acquisitions, and unit closures — and seeking a SNAP waiver to bar the purchase of energy drinks and candy.
The $50 billion Rural Health Transformation Program fund was added to the legislation, known as OBBBA, amid concerns about how the bill’s Medicaid cuts would impact rural facilities. Mehmet Oz, the administrator for the Centers for Medicare & Medicaid Services called the program “a spaceshot that will allow us to completely re-envision how rural health care is offered in this country.”
Half of the $50 billion grant will be evenly divided among all approved states. The other $25 billion will be based on the sole discretion of CMS and will take into account the rural makeup of states plus other factors “the administrator determines appropriate.”
A DSS spokesperson said the agency hopes to hear next month regarding the state’s application but won’t know until then how much funding Connecticut will get.
Rural health care has long faced a complex combination of challenges. People living in rural areas of the country are at higher risk for certain conditions, like fatal heart disease and stroke. At the same time, serving small populations makes it difficult for these facilities to generate scale and recruit doctors, nurses and hospital staff.
Connecticut’s rural hospitals are all underperforming financially when compared to the state’s hospitals overall. Rural residents face a median drive time of 32 minutes to a trauma center and 26 minutes to a stroke center, according to the state’s application. Since 2023, the state has approved the closure of two of its four rural maternity units — at Johnson Memorial and Windham Hospitals.
Even with a $50 billion funding opportunity, providers around the country are expressing concern about the impact of anticipated Medicaid changes in H.R. 1. Nonprofit research organization KFF estimates the law will result in a $137 billion hit to Medicaid funding in rural areas over 10 years — “about $87 billion more than is appropriated for the rural health fund,” researchers note.
“For rural hospital systems that are already facing strain or operating on thin margins, there’s been a really widespread concern that decreased revenue and increasing costs related to uncompensated care will put additional pressure on those health systems,” Katie Greene, director of population and public health at the National Academy for State Health Policy, said.
A spokesperson for the federal Department of Health and Human Services referred to comments by Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, who said the Rural Health Transformation Program would increase health funding to rural Americans by 50%.
“To put it in perspective, about 7% of Medicaid dollars go to rural health care. That’s about $19 billion a year. This fund is $10 billion a year for 5 years. So [that’s] a 50% increase in the amount of money that Medicaid will pay into rural health care,” Oz said during a September Senate Republican leadership press conference.
Multiple health policy researchers have called Oz’s assertion misleading.
Paul Kidwell, senior vice president of policy at the Connecticut Hospital Association, called the Rural Health Transformation Program “a positive measure” to address rural health challenges, but added that “it will not do enough to make up for the harmful impacts” of H.R. 1.
“Nearly $1 trillion in Medicaid cuts will cause significant harm to healthcare access and affordability in every state and strain the nation’s entire healthcare delivery system hurting hospitals and patients in every community, including rural communities, all the same,” Kidwell wrote in emailed comments.
Day Kimball CEO Kramer said the Medicaid cuts keep him up at night. But, he’s still excited about the opportunity the program presents to reassess how they deliver health care in their rural community and address health needs before they become emergencies.
“The American health care system is one of the absolute best in the world at treating patients with complex diseases. We earn that reputation for treating people once they’ve gotten to the point where they have these very serious illnesses,” Kramer said. “[What] if we flip the script a bit and start to think about ‘What could we do to potentially prevent some of that risk?’”